Abstract Background and aims Intracerebral haemorrhage (ICH) incidence is elevated in patients with liver cirrhosis (LC). Mechanisms include coagulopathy and suspected microvascular dysfunction likely persisting beyond correction of haemostatic abnormalities. We report 2 patients presenting with ICH and underlying LC. Methods Our study includes 2 patients admitted to the ED of a large UK District General Hospital in 2025. Hyperacute management followed the ABC approach and deranged INRs (1 patient with thrombocytopenia) were managed with IV VITK (+ PCC for 1 patient). Patients did not require neurosurgical intervention and were transferred to the HASU. Results A 46F (mRS0) with EtOH-related LC presented following a collapse with right-sided paralysis and sensory loss. CT imaging demonstrated a large left frontoparietal ICH with intraventricular extension and no underlying small vessel disease (SVD)/neurovascular malformation (NVM). INR normalised and serial MRI/MRA imaging demonstrated absence of haematoma expansion and no microhaemorrhages, space-occupying lesion, or NVM. Discharge mRS was 4 and the patient continues to recover. A 67M (mRS3) with LC, EtOH excess and treated hypertension presented with a GCS 11/15 and right-sided paralysis. CT imaging revealed a moderate subcortical left parietal ICH, mild periventricular SVD and no NVM. The patient sadly developed fatal non-resolving status epilepticus in absence of haematoma expansion or other structural brain causes. Conclusions Both cases highlight that (i) ICH with underlying LC requires complex MDT-driven management, (ii) LC screening should be considered in patients with no convincing precipitating ICH causes and (iii) further studies are required to investigate possible cerebral microvessel dysfunction/instability in patients with LC. Conflict of interest Dr Jemima Atputharatnam: nothing to disclose, Dr Hlaing Ni: nothing to disclose, Dr Julian Schwartze: nothing to disclose
Atputharatnam et al. (2026) studied this question.